Separating Fact and Fiction Surrounding ‘First Cannabis Death’

Mysterious Death of 11 month old Boy Sparks Controversy After Media Reports

A Child’s Tragic Death

In 2015, an 11-month-old boy was brought to the ER in Colorado. For the past two days, he had been lethargic and retching before suffering a seizure that morning.

Unfortunately, at the hospital, he went into cardiac arrest and died. Doctors attempted for an hour to resuscitate him before pronouncing him dead. Prior to this, the boy had been normal and healthy.

The doctors overseeing the case were mystified, as the autopsy later revealed that the boy had myocarditis – inflammation of the heart muscle – a condition rare in a child so young. All other causes of myocarditis, such as bacterial and viral infections and allergic reactions, were ruled out. What was mystifying was that urine tests came back positive for THC.

In the case report, published in March of 2017, authors Dr. Thomas Nappe and Dr. Christopher Hoyte wrote, “a possible relationship exists between cannabis exposure in this child and myocarditis leading to death.” The report went on to recommend further research into this possible association and the counselling of parents to prevent exposure to cannabis.

A full eight months later, the Reno Gazette Journal picked up the story with their headline reading “Colorado Doctors Claim Baby Boy is First Marijuana Overdose Death”.

Whether simply misreading or misunderstanding the case report or intending to sensationalize the report’s conclusion, the Reno Gazette Journal’s article would spark controversy across the cannabis and medical communities.  

The Controversial Case Report

Case Reports, by nature, do not make definitive claims. Rather, they are detailed narratives of a medical occurrence, recording signs, symptoms, diagnosis, and treatment. Case reports are primarily used in education and research and help create a record in medical literature of unusual events.

That was Nappe and Hoyte’s intention when they authored their report on the 11-month-old boy. They sought to record the incident and alert their colleagues and peers of the possible relationship between cannabis and myocarditis.

case report

“We published this case report to share what we observed with the medical community.  A child presented with a seizure and then cardiac arrest, and was determined to have passed away suddenly from myocarditis.” Nappe told Medical Marijuana, Inc. “ As often is the case, the cause of the myocarditis was unknown. It was unusual that the child tested positive for Δ-9-carboxy-tetrahydrocannabinol, a metabolite of tetrahydrocannabinol.”

The report is not the first to associate marijuana to a heart-related death or even the first to link cannabis to myocarditis. A report published in September of 2016 similarly recorded a link between cannabis exposure and myocarditis in a 15 year old patient.

“Given this sequence of events, and prior case reports that aim to associate cannabis with myocarditis, this report was shared to motivate further study and research to attempt to establish if there could be a causal relationship between marijuana and myocarditis,” Nappe said.

Nappe and Hoyte wrote in the report, “the authors urge clinicians to preventively counsel parents and to include cannabis exposure in the differential diagnosis of patients presenting with myocarditis.”

As for whether the report claims that the child’s death was definitively caused by cannabis, Nappe told us, “The report states an association may exist based on the sequence of events in this case. At this time there is no evidence of causality, and this most certainly was not proof of a marijuana overdose. The report never made any claims of causality.”

Truth Exaggerated by Media

The case report went seemingly unnoticed for nine months until the Reno Gazette Journal, nearly a year later, narrowed in on a single line in the report, “this is the first pediatric death associated with cannabis.” It is this line that would cause a wave of controversy.

In his conversation with Medical Marijuana, Inc., Nappe noted that the word “associated” is commonly used in this context and in no way is a definitive claim of a causal relationship between cannabis and myocarditis.

media exaggeration

That didn’t stop a number of news outlets from re-running the story of the first pediatric death from cannabis exposure, and soon the story was hitting major news outlets like the New York Post, Washington Times, NBC News, and Newsweek, all of which wrote that the doctors claimed the death was a cannabis overdose. Eventually, Snopes would debunk the claim as false, revealing the truth behind what the case report actually said.

Children’s Safety

The true tragedy here, once the controversy settles, is that the young boy’s cannabis exposure could have been prevented. Regardless of whether or not the boy’s death was caused by cannabis, parents must be more careful to keep cannabis-infused products out of reach of children.  

The authors of the report didn’t know the route and timing of exposure, but detected THC metabolites at levels above what can be expected from “passive exposure”. The report states that the child experienced an “unstable motel-living situation” and the parents admitted to drug possessions, including cannabis.

Research from the University of Colorado Anschutz Medical Campus revealed that nationwide, “There were 985 unintentional marijuana exposures reported from 2005 through 2011 in children aged 9 years and younger.”

Colorado regulations require that cannabis products be sealed in childproof packaging, not contain the word “candy”, and not be in “kid-friendly shapes” like bears and worms. Despite these rules, accidental exposure to THC still occurs.

Nappe told Medical Marijuana, Inc., “During my medical toxicology fellowship at the Rocky Mountain Poison and Drug Center, it was not uncommon to be called to evaluate symptomatic, small children who were exposed to marijuana. These were usually due to inadvertent ingestions of marijuana products accidentally left in the reach of children.”

A similar study out of the University of Colorado to the one listed above looked at cases of cannabis exposure among children under 10 between January 1, 2009, and December 31, 2015, at a single location – Children’s Hospital Colorado, Aurora. 163 marijuana exposure cases were found in this one hospital, with a median age of about 2 years old. In 48 percent of these cases, it was known that a cannabis-infused edible was at fault.

In the aftermath, Colorado has created a tip sheet for parents that gives parents ideas for ways to ensure their children are not exposed unintentionally to marijuana.

“The concentration of THC is fairly significant in commercially available marijuana and that is very important when ingested by a small child,” Nappe said. “The presentations of these children varied. Although somnolence, nausea, and vomiting were common, we also observed alterations in heart rate and blood pressure, respiratory depression, lethargy, and, rarely, seizure activity. Parents need to be vigilant in keeping these products out of the presence of children, as the effects can have serious consequences.”

The truth of the matter is that every other time a child was admitted to a hospital with cannabis exposure in the U.S., they went home alive. “It is the norm that these children do well with good supportive care and monitoring when it is realized early,” Nappe stated.

For whatever reason, though, this time the patient didn’t get to go home – a point that sticks with those involved in this case.

Further Research

The case report also calls for research into the possible link between cannabis and myocarditis, saying, “we believe there exists a plausible relationship that justifies further research into cannabis-associated cardiotoxicity and related practice adjustments.”

As for the case of the deceased child detailed in their report, “Cases like this are rare in the emergency department and rare in general. However, pediatric exposures to marijuana are not uncommon. More research into the cardiac effects of cannabis can lend itself to further awareness and precautionary measures,” Nappe concluded. “We want to properly educate our patients as our society is moving toward medical and recreational marijuana legalization. It is always better to prevent problems before they occur. However, how we treat such events may change based on the etiology.”

Only further research into this potential relationship between cannabis and the effects seen in this small boy can definitively give us an answer to what happened and help guide future course of action when a case such as this arises.

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